This information is intended for U.S. healthcare professionals and/or
healthcare professionals involved in healthcare reimbursement.

This site is intended for U.S. residents 18 years of age or older.

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This information is intended for U.S. healthcare professionals and/or healthcare professionals involved in healthcare reimbursement.

This site is intended for U.S. residents 18 years of age or older.

Forms and resources for you and your patients

Forms and Documents
Video Resources

Below is a library of resources, including CMS forms, checklists, and appeal template letters. Educational guides are also available to help your patient navigate the insurance coverage process and understand how BMS can support them throughout their treatment journey.

Most Requested Downloads

Enrollment forms, coding and reimbursement guides, and an introduction to getting started with BMS Access Support^®.

Oncology Enrollment Form

OPDUALAG™ (nivolumab and relatlimab-rmbw) Reimbursement and Coding Guide

OPDIVO^® (nivolumab) Reimbursement and Coding Guide

Getting Started with BMS Access Support: An HCP Guide

Blank CMS-1500 Form

Standard claim form for physician office.

Blank UB-04/CMS-1450 Form

Standard claim form for hospital outpatient.

Forms & Template Letters

Patient Benefits Information Form

Benefits and coverage summary form for patients.

Medically Unlikely Edit (MUE) Appeal Template Letter*

This template is offered as a resource to use when writing to appeal the Medically Unlikely Edit (MUE) that is in place for a certain drug and to provide documentation of the medical necessity of that drug.

Medical Necessity Template Letter*

Template letter to document the medical necessity of a drug.

Prior Authorization Denial/Redetermination Appeal Template Letter*

Template letter to request a First-Level/Second-Level Appeal by a Medical Advisor for the prior authorization denial of a drug.

Commercial Claim Denial Appeal/Redetermination Template Letter*

Template letter to request a First-Level/Second-Level Appeal by a Medical Advisor of the denial of a drug.

Open Access Template Letter*

Template letter to appeal for coverage if payer’s policy has denied access to a product.

Alternative Funding Program (AFP) Appeal Template Letter*

This template is offered as a resource to use when appealing the denial of coverage for a BMS Medication by the patient’s health benefits company.

*Template letters are provided as examples of potential correspondence.

Checklists

Peer-to-Peer Medical Checklist

If a patient has been denied coverage for a medication by a payer, a peer-to-peer review may be warranted for approval. Review this checklist to support the patient’s treatment rationale.

Letter of Medical Necessity Checklist

Critical points to consider covering in a Letter of Medical Necessity if your patient has applied for and been denied health plan coverage for a BMS product you wish to prescribe.

Guides

My BMS Cases User’s Guide

A user guide for our online provider portal designed to help you assist patients with enrolling in BMS Access Support^® programs.

A Guide to Electronic Benefits Reverification (eBRV)

A guide to reverifying benefits for your patients currently enrolled in BMS Access Support and receiving BMS medications.

Getting Started with BMS Access Support: An HCP Guide

An introduction to BMS Access Support for healthcare professionals.

HCP Reimbursement Process Map

A step-by-step process map of the healthcare professional reimbursement journey.

Understanding Your Healthcare Benefits

Information about how health insurance may help patients pay for treatment.

A Guide to Medicare Part D

A guide to the four phases of Medicare Part D.

Low-Income Subsidy Brochure

A guide to Medicare low-income subsidy for patients with limited income or resources.

Patient Brochure

An overview of services BMS Access Support provides to patients.

Patient Reimbursement Process Map

A step-by-step process map of the patient reimbursement journey.

The educational videos below are available to help you and your patient navigate the insurance coverage process and how BMS Access Support^® can help support the treatment journey.

Enrollment Form Tutorial

What is an Explanation of Benefits (EOB)?

What is Health Insurance?

Get to Know BMS Access Support

Enrollment Form Tutorial

Helping patients enroll for support programs can present unique challenges. Watch this video and learn about the enrollment process for BMS Access Support.

This video is intended for HCPs.